We want scheduling an appointment at Dental Health Associates of Madison to be easy and fast. Whether you are a new patient or a returning one, try our online form below.

Complete the form below to request your appointment, ensuring all fields are filled out. Be sure to keep in mind that all appointments can take a different amount of time, so sometimes your requested dates may not be available to you. If you do not see your type of appointment below, or have questions about what to choose, please call our office.

We will contact you to confirm your final appointment date and time.

Please do not use this form for emergencies or to cancel or change an existing appointment. Please call the office to do this.

Appointment Request Form

ALL fields are REQUIRED unless marked optional

Select a location:

Dentist(s)

Are you a new patient?

Yes

No

How did you hear about us?

Patient Information

First name

Last name

Phone numbers must include area code, numbers only and no spaces

Day time phone

Evening time phone

Email

Appointment Request Details

Reason for visit:

Additional information

Optional

Preferred Day(s):

Check all that apply

Any day

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred Time(s):

Check all that apply

Any Time

Early Morning

Mid Morning

Afternoon

Mid Afternoon

For security purposes, please match the slider below to send the form.

People talk with me

Appointment Request

24/7 Access to this online appointment allows you to take care of your scheduling needs any time, anywhere. It's mobile friendly, too.

Insurance

Medical and dental insurance can be confusing. Our staff has experience with your questions and can help you get the most from your insurance.

Online Bill Pay

Pay your bills online, anytime of day. Payments also accepted via phone during normal business hours or by mail.